宫腔镜手术中膨宫压力与子宫内膜异位的关系

Relationship between uterine distention pressure and endometriosis in hysteroscopic surgery

目的探讨宫腔镜手术不同膨宫压力对子宫内膜细胞(PFC)异位的影响,为宫腔镜手术的安全操作寻找一个安全可靠的压力数值。方法选择我院180例行宫腔镜手术的患者随机分为A、B、C三种各60例,膨宫压力分别为40～80 mmHg、80～120 mmHg、120～160 mmHg,观察三组手术情况及术前术后行腹腔镜直视下抽取盆腹腔灌洗液做PFC的检测。结果术后A、B、C三种盆腹腔灌洗液PFC的阳性率分别为28.33%(17/60)、43.33%(26/60)、85.00%(51/60);A组术中操作视野欠佳,B、C组术中操作视野良好;A、B组术后无子宫内膜异位情况,C组术后4例出现子宫内膜异位症状。结论宫腔镜手术治疗效果及预后与术中膨宫压力有关,宫腔镜术中膨宫压力80～120mmHg是最佳压力数值,既方便手术操作又不引起子宫内膜异位到盆腔。

Objective To investigate the influence of different urine distention pressure on ectopic endometrial cell （EC） in hysteroscopic surgery in order to find a safe and reliable pressure value for the safe operation of hysteroscopic surgery. Methods One hundred and eighty patients receiving routine hysteroscopic surgery in our hospital were ran- domLy divided into group A,group B and group C,with 60 patients in each group, of which the uterine distension pres- sure was 40-80 mmHg 80-120 mmHg and 120-160 mmHg respectively. The intraoperative situation of the 3 groups was observed and the abdominal lavage fluid was extracted under laparoscopy before and after surgery for the purpose of EC detection. Results The positive rates of EC cells in abdominal lavage fluid of group A, group B and group C af- ter surgery were 28.33% （17/60）,43.33% （26/60） and 85.00% （51/60） respectively. The intraoperative operation view of group A was poor andthe operative view of group B and group C was good. No postoperative endometriosis was observed in group A and group B and postoperative endometriosis symptoms were discovered in group C. Conclusion The curative effect and prognosis of hysteroscopic surgery were related to the intraoperative distention pressure and the distension pressure of 80-120 mmHg is the optimal pressure value,which is convenient for surgical operation and causes no endometriosis to the pelvis.